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Spousal Involvement in the Workplace of Doctors: What Is Defined as appropriate or Inappropriate

Health 2024年第3期16卷 187-203页

作者： Uchenna Onubogu Boma Oyan Martha Okorie Department of Paediatrics & Child Health Rivers State University Teaching Hospital Port Harcourt Nigeria

Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to determine the prevalence and extent of spousal involvement in physicians’ workplaces as well as the outcome of such involvement on doctor’ swell-being, productivity, and relationship with colleagues. Methods: This cross-sectional online survey on spousal involvement in the workplace of doctors was conducted among 83 responding doctors from July to August 2023. Results: Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace. The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%). Spouse’s ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of inappropriate spousal involvement in the workplace, while expression of love for spouse with acts of kindness was significantly associated with a lowered odd of inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001). Conclusion: Spousal involvement in the workplace is relatively common. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors. The establishment of workplace policies that define the limits of spousal involvement in the doctor’s workplace can foster a healthy workspace environment, enhance doctors’ well-being, and improve patient care.

关键词： Spouse Workplace Involvement Hospital Healthcare Workers Conflicts appropriate

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appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

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Journal of Biosciences and Medicines 2024年第3期12卷 337-354页

作者： Renata Shihmanter Olga Lazar Lidia Arcavi Clinical Pharmacology Unit Kaplan Medical Center Rehovot and Hebrew University Hadassah Medical School Jerusalem Israel Department of Medicine Kaplan Medical Center Rehovot and Hebrew University Hadassah Medical School Jerusalem Israel

Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.

关键词： Amikacin Therapeutic Drug Monitoring appropriate Clinical Pharmacologist Safety Adverse Effects

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appropriate use criteria for cardiac catheterization and coronaryrevascularization

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Chinese Medical Journal 2014年第6期127卷 1161-1165页

作者： Jack P.Chen Thach Nguyen Faisal Latif Theodore A.Bass Department of Medicine Northside Hospital Atlanta Georgia USA Indiana University School of Medicine Community Healthcare System St Mary Medical Center Hobart Indiana USA Department of Medicine Cardiovascular Section VA Medical Center and University of Oklahoma Health Sciences Center Oklahoma CityOklahoma USA Division of Cardiology University of Florida USA

Challenges Since its inception,the field of invasive and interventionalcardiology has witnessed tremendous procedural andtechnological advancements,thereby offering quantumexpansion in clinical applications.As the com... 详细信息

关键词： appropriate use criteria cardiac catheterization percutaneous coronary intervention treadmill risk factors

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appropriate Strategies for Rural Houses In Northwest China

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湖南大学学报（自然科学版） 2009年第S1期36卷 167-171页

作者： HE Quan,LIU Jia-ping,LU Xiao-hui,YANG Liu(School of Environmental & Municipal Engineering,Xi’an University of Architecture and Technology,Xi’an,Shaanxi 710055,China) School of Environmental and Municipal Engineering Xi'an University of Architecture and Technology Xi'an 710055 China

To avoid the old road of urban development with high consumption and high pollution,this paper took the houses in a village near Yinchuan(a typical city of Northwest China)as an exemplary project to explore the appropriate strategies in the arid cold climate for the sustainable development in rural undeveloped areas Northwest China.Firstly,all houses were designed according to the principles of passive solar heating.Secondly,optimized biomass energy technologies such as biogas pit and straw gasification stove were utilized for cooking or heating.Last but not the least important,the ecological building materials such as earth,straw bale,fly ash were used to construct houses,which improves the indoor thermal comfort and meanwhile lowers the negative impact on the environment.Low costs,easy accessibility and habitants' inclination were taken into account in the process of design.

关键词： appropriate strategies arid-cold climate passive solar heating optimized biomass energy ecological building materials

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appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia

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World Journal of Gastroenterology 2015年第12期21卷 3587-3592页

作者： Hyun Park Ki Jun Jang Won Jang Sang Hoon Park Ji Young Park Tae Joo Jeon Tae Hoon Oh Won Chang Shin Won-Choong Choi Dong Hyun Sinn Department of Internal Medicine Sanggye Paik Hospital Inje University Department of Medicine Samsung Medical Center Sungkyunkwan University School of Medicine

AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality. RESULTS: The mortality rate at 30 d was 30.4%(31/102 episodes). Use of AEA was associated with better survival at 30 d(76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic(IEA) use was an independent factor associated with increased mortality(OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, ChildPugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired. CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.

关键词： Liver cirrhosis Bacteremia appropriate antibiotics

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Differential Impact of appropriate Use Criteria on the Association between Age and Abnormal Stress Myocardial Perfusion SPECT

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Cardiovascular Innovations and Applications 2019年第B4期4卷 63-69页

作者： Saurabh Malhotra,MD,MPH,FACC,FASNC Rami Doukky,MD,MSc,FACC,FASNC,FASE Division of Cardiology Cook County HealthChicagoILUSA Division of Cardiology Rush University1653 W.Congress Parkway ChicagoIL 60612USA

Background:The diagnostic and prognostic value of appropriate use criteria(AUC)for coronary artery disease(CAD)is well established.Whether the diagnostic yield of AUC for predicting CAD is preserved among the elderly is not known.Methods:We analyzed a multisite prospective cohort of 1511 consecutive patients(age 59±13 years,57%males)who underwent outpatient,community-based single-photon emission computed tomography(SPECT)myocardial perfusion imaging(MPI).appropriateness of the studies was determined on the basis of the 2013 multimodality AUC for detection and risk assessment of stable ischemic heart disease.Abnormal SPECT MPI was defi ned by either a summed stress score of 4 or greater or a summed difference score of 2 or greater.Results:Abnormal SPECT MPI was present in 190 patients(12.5%),while ischemia on MPI alone was present in 122 patients(8%).In multivariate logistic regression analysis,age of 60 years or greater,male sex,hypertension,diabetes mellitus,and known CAD were independent predictors of abnormal SPET MPI,while appropriate indication for testing was not.Age of 60 years or greater was also an independent predictor of inducible myocardial ischemia,while appropriate indication for testing was not.Among the elderly(≥60 years),regardless of appropriateness of testing,there was no difference in the prevalence of abnormal SPECT(19 vs.14%,P=0.14)or prevalence of SPECT ischemia(11 vs.11%,P=1.00).Among younger patients,however,appropriate testing predicted a greater prevalence of abnormal SPECT(12 vs.7%,P=0.013).Conclusion:In this multisite cohort,testing based on AUC did not discriminate the risk of abnormal SPECT MPI among the elderly.Caution is advised when relying on AUC for referral of elderly patients for SPECT MPI.

关键词： appropriate use criteria myocardial perfusion imaging age coronary artery disease single-photon emission computed tomography

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Building momentum for sustainable behaviors in developing regions using Locally Managed Decentralized Circular Economy principles

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Chinese Journal of Chemical Engineering 2019年第7期27卷 1566-1571页

作者： Chandni Joshi Jeffrey Seay Department of Chemical and Materials Engineering University of Kentucky

Despite the current threat from climate change,plastic collecting in the world's oceans,and the steady loss of biodiversity,the world continually fails to take action with regard to our rapidly changing ecosystem.Unfortunately,waiting on governments to act is no longer a viable option.Rapid change is needed and the pace of diplomacy is simply too slow.Democratic governments are reactionary and taking action to solve future problems is not a priority,even as the threat of potential ecological catastrophe draws ever closer.Change is in the hands of individuals,and it is our decisions and behaviors that will influence the future of our planet and our ability to inhabit it.Therefore,building momentum for sustainable behavior must begin with individuals.The neoliberal approach to environmental protection posits that individuals are motivated by rational self-interest,and that economic incentives are necessary to achieve environmental goals.However,recent research suggests that monetary gain alone actually negatively impacts behavior,and often neglects the rural poor.As a result,models for projects designed to benefit the environment need more than just a monetary incentive,they must incorporate all three pillars of sustainability:environment,economy and society.One approach for building momentum for sustainable behavior with regard to municipal solid waste management,particularly in the developing world,is by implementing Locally Managed Decentralized Circular Economy(LMDCE)principles.This contribution will describe the role behavioral economics plays in the choices made by producers and consumers.The results of a case study on applying LMDCE principles in Uganda to manage waste plastic accumulation by conversion to fuel oil will be presented.

关键词： Pyrolysis Fuel Pollution appropriate technology Behavioral economics Municipal solid waste

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appropriate Listening Materials in Business English Teaching

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海外英语 2015年第8期 23-25页

作者：李丹湖南铁道职业技术学院运管学院

Business English is a branch of ESP(English for specific Purpose),which determines its vocational and professional orient and its focus on learning for reality,work and professions,so applying real and authentic content in Business English teaching is suggested to be helpful both in theory and in practice.However,compared with other L2 skills teaching,to some points,listening input turns out to be problematic and uncertain in terms of utilization and selection of authentic listening materials currently.This article tries to present the problems and analyze to what extent these problems can be tackled by suggesting some appropriate listening materials.

关键词： Business English authentic listening materials appropriate listening teaching

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appropriate Technologies for Improving Yield and Income of Small Holders Growing Rice Paddy in Rainfed Low Lands of Agro-Biodiversity Hotspots in India

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Agricultural Sciences 2019年第11期10卷 1497-1505页

作者： Syed Abubacker Siddick Natural Resources Management Hand in Hand India Kanchipuram India

Rainfed paddy production accounts for 30% of rice production in India and supports the nutrition of some of India’s poorest farmers. Agro-biodiversity hotspots in India such as Kollihills are rich in genetic variability of economically important staple crops such as rice, millets and tubers inhabited by tribal malayali farmers who largely depend on rice as food for their subsistence. Poor agronomic practices, inadequate water and fertilizer management in growing improved rice varieties resulted in a 50% yield reduction compared to yields obtained from improved package of practices of similar farming situation. Farmers participatory research conducted by M. S. Swaminathan Research Foundation, India and University of Alberta Canada, in rice paddy cultivation in two seasons of subsequent years 2012 and 2013 showed that adoption of appropriate technologies in rainfed low land paddy help small farmers reaching doubled their yield and income than control.

关键词： Lowland Paddy Kolli Hills appropriate Technologies

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appropriate Use of Cardiac Magnetic Resonance Imaging and Its Impact on Downstream Resource Utilization

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World Journal of Cardiovascular Diseases 2017年第8期7卷 243-250页

作者： Tiberio Frisoli Joseph Gibbs Karthik Ananthasubramaniam Heart and Vascular Institute Henry Ford Hospital Detroit MI USA

Purpose: Echocardiography and nuclear perfusion imaging studies ordered for appropriate indications by appropriate Use Criteria (AUC) have been shown more likely to impact management than studies deemed inappropriate or uncertain. We sought to evaluate the appropriateness of indications for all cardiac magnetic resonance imaging (CMR) testing done at our institution in 2011, and to what extent appropriateness of CMR was associated with impact on patient management. Methods: This was a single-center retrospective cohort study including 239 consecutive patients who received CMR over the 12-month calendar period in 2011. CMR studies were classified as appropriate, uncertain or inappropriate based on the 2006 AUC. A study was deemed to have had impact if it changed or clarified the patient’s diagnosis or directly influenced downstream decision-making by subspecialty referral, further testing or treatment changes. Results: The most common indications for CMR included evaluation of cardiomyopathy (79%), valvular pathology (8%), suspected myocarditis (8%), and cardiac masses (5%). Of CMRs performed, 96% were appropriate, 1% inappropriate, and 3% uncertain. appropriate CMRs were more likely to be associated with changes in management (90%) than inappropriate or uncertain studies (40%), with an odds ratio of 21.5:1. The most common reasons CMR classified as appropriate did not change management were 1) incomplete study, 2) physician judgment not to take action based on the CMR result and 3) hypertrophic cardiomyopathy in specific circumstances. Conclusions: appropriate CMR studies were more likely to impact management than inappropriate/uncertain studies. When ordered for appropriate indications, CMR has demonstrable impact on patient management decisions.

关键词： Cardiac MRI appropriate Use Criteria Utilization Cardiac Imaging

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